Tax changes should be seen as a gateway to a larger discussion on reform of public health care in Canada
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* Jillian Ratti
* Michaela Beder
* Vanessa Brcic
* Gary Bloch
* Lesley Barron
* Monika Dutt
* Samantha Green

We read with concern the recent editorial on the government’s proposal to eliminate certain tax advantages for incorporated physicians and other small businesses.1 We appreciate the call for respect and maintaining common ground, and agree that a meaningful exchange of ideas, free of bullying, is the best path forward. In this context, it is somewhat ironic that the letter we signed on tax reform was dismissed as “frankly naive.”

The editorial misses the mark on the content of our letter, which explicitly calls for broader tax system reform while acknowledging that the current proposed changes are a small step toward that goal. We believe the best way to advocate for reform is by supporting the proposed changes that move us in that direction and then holding the government accountable for further required reforms.

In addition, as physicians with great social privilege, we believe it is our responsibility to consider the larger social context when advocating around reform of the tax system: we live in a country where the average Canadian makes a fraction of what physicians earn, and where precariousness of work is increasingly common. Our actions and words need to reflect these concerns.

Further dialogue about strategy and the process of reform is welcome and important to ensure accountability. We see this policy moment as an opportunity to move forward on long-standing challenges our profession has faced, and we are asking for parental benefits and access to pensions for physicians (and all Canadians), alongside a dialogue on securing appropriate models of compensation. We call upon our medical associations to focus on a full examination of payment reform, including the option of offering physicians salaried compensation and benefits — a model that prevails in many of the highest performing health systems internationally.

We are heartened by the recognition of common priorities for advocacy including payment reform, benefit options and a fair and transparent proces of tax reform. However, we are concerned that the vehement opposition to the tax reforms adopted by most medical associations may be harmful to our profession’s reputation and credibility.

Thus, we reiterate our call to refocus advocacy onto smart, equitable and evidence-based policy solutions that address the underlying issues in this debate. Going forward, a more astute, nuanced and balanced political strategy would help us pursue the common objectives of a tax system that improves the well-being of physicians and all people living in Canada, and a health care system that does the same.

## Footnotes

*   **Competing interests:** The authors are a group of both incorporated and unincorporated physicians.

## Reference

1.  Stanbrook MB. Tax reform plays politics with doctors’ reputations [editorial]. CMAJ 2017;189:E1249.
    
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